관상동맥 방사선 치료 후에 발생한 재협착 병변에 대한방사선 재치료의 장기 효과 = Long-Term Effect of Repeated Brachytherapy in IntracoronaryBrachytherapy Failed Lesions

다국어 초록 (Multilingual Abstract)

Background and Objectives：An intracoronary brachytherapy is the only approved treatment for in-stent restenosis. However, a considerable rate of restenosis occurs after a brachytherapy. Up to now, there was no long term outcome for repeated brachytherapy for these lesions. Subjects and Methods：Eleven patients were admitted due to angina, with significant ischemic evidence in the stress test after the intracoronary brachytherapy. These patients were re-treated with a β-emitting 188 rhenium-DTPA (diethylene triamine penta-acetic acid) filled balloon catheter system, using an identical method and radiation dose (17.6 Gy) to the initial radiation treatment. The long term angiographic and clinical outcomes of repeated brachytherapy in these patients were evaluated. Results：The angiographic and clinical data of ten patients were evaluated, as 1 was lost. The follow-up period was 37.4±16.2 months (range, 8 to 53 months). There was no angiographic restenosis or target lesion revascularization (TLR) during the short term follow-up period (mean 6 months). but 2 restenosis (25%) occurred in the 2 year follow-up period and one other was added during the long term clinical follow-up period. All these restenosis lesions needed revascularization. These three TLRs occurred at 15, 24 and 43 months after the repeated brachytherapy. There was no death or nonfatal MI. No vascular perforation, aneurysm or late thrombosis was observed. Conclusion：A repeated brachytherapy for the treatment of a failed intracoronary brachytherapy lesion is safe and acceptably effective during the long term follow-up period. This modality might be considered as a therapeutic option for failed intracoronary brachytherapy lesions.

국문 초록 (Abstract)

배경 및 목적：방사선 치료는 스텐트 내 재협착에 효과를 인정 받은 유일한 치료법이나 지속적으로 재협착이 발생한다. 이에 대한 치료법으로 현재까지 단기 추적에서 좋은 효과를 낸 것은 방사선 재치료이지만 아직 장기적인 안전성과 효과에 대한 보고는 없는 상태이다.방 법：방사선 치료 후 발생한 재협착 환자들 중 11명에게 188Re-DTPA(rhenium-188 diethylene triamine penta-acetic acid)로 채워진 관상동맥 풍선도자를 사용하여 1차 방사선 치료와 같은 방법과 방사선량으로 풍선도자-혈관벽 계면으로부터 1.0 mm 깊이에 17.6 Gy를 조사한 후 혈관 조영술상의 특성과 임상 경과를 분석하여 방사선 재치료의 장기적인 안정성과 효과 등을 후향적으로 추이하였다.
결 과：
1명의 환자가 조기에 추적이 안되어 10명의 혈관 조영술과 임상 성적을 분석하였다. 총 추적기간 37.4±16.2개월(8~53개월)이었다. 평균 6개월간에 걸친 단기 추적에서는 유의한 재협착이나 목표 병변 재개통술의 발생이 없었다. 2년 추적 기간에 2명에서 협착과 이에 연관된 목표 병변 재개통술이 발생하였다(25%；8명 중 2명). 2년 혈관 조영 추적 이후에 실시된 임상 경과 추이 도중 1명에서 협착과 이에 연관된 목표 병변 재개통술이 추가적으로 발생하여 목표 병변 재개통술은 방사선 재치료 후 15, 24, 43개월에 발생하였다. 추적 기간 동안 사망, 심근경색을 일으킨 예는 없었으며 관상동맥 천공, 혈관류 혹은 후기 혈전증 등은 없었다. 평균 6개월의 단기 추적에서는 목표 병변 재개통술이 발생하지 않았다.
결 론：
장기적인 추적을 통하여 관상동맥 방사선 치료 후에 발생한 재협착 병변에 방사선 재치료는 안전하고 효과적인 치료법으로 생각되며 관상동맥 방사선 치료 후에 발생한 재협착 병변에 대한 치료 방법으로 고려하여야 할 방법이라 하겠다.

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